Research over the past two decades has uncovered many interesting facts about the links between addiction and Anxiety. Does one cause the other? Could the presence of both be one and the same condition?

When a substance abuse problem co-exists with a mental health issue such as depression, anxiety or bipolar disorder, we have what is called a dual diagnosis or co-occurring disorder. For those already battling with substance abuse, in some ways this is like taking on a bigger, invisible enemy. But there are steps you can take to win this battle. A combination of proper treatment, support and self-help strategies is vital.

How common is it?

Being diagnosed with both conditions at the same time may seem like an unlucky quirk of fate, but it is not uncommon. According to reports published in the Journal of the American Medical Association:

As many as 50 percent of people with severe mental disorders were also affected by substance abuse.

37 percent of alcohol abusers and 53 percent of drug abusers also had at least one serious mental illness.

Of all those diagnosed as mentally ill, 29 percent abused either alcohol or drugs.

Source: National Alliance on Mental Illness

What comes first?

When we look at substance abuse and mental illness separately, we find that both have in common a set of symptoms that can impact all those things we take for granted: our ability to handle the ups and downs of life, our relationships with others, even the way we physically function. It’s important to consider the way both of these disorders affect each other. Just as a mental health problem gets worse when it’s not treated, drug or alcohol addiction commonly gets worse too. When substance abuse increases, mental health problems tend to escalate also.

But while addiction is common in people with mental health issues, one is not the direct cause of the other. Here are the key ways the two interact:

People with depression or bipolar often rely on alcohol or drugs to self-medicate. While turning to drugs or alcohol can temporarily numb the pain, over the long term it can intensify the original symptoms.

Substance abuse can increase a pre-existing risk of mental illness. It’s estimated that 1 in 5 people carry a diagnosable mental health condition, while the rest of us have varying degrees of risk or vulnerability. If you already possess an underlying mental illness, drug or alcohol abuse may bring it to the surface.

Substance abuse can intensify the symptoms of a mental health condition. Alcohol and drug abuse may significantly increase symptoms of mental illness or give rise to new symptoms. Substance abuse also interacts with medications including antidepressants, anti-anxiety medication, and mood stabilisers, reducing their effectiveness.

Being honest with yourself

Identifying a mental health issue is a complex process and can take time to determine with certainty. Similarly, knowing for sure that a drug or alcohol problem is present can be fraught with difficulty.

Denial is one of the biggest obstacles that can block a dual diagnosis. It’s not easy to admit how dependent you are on alcohol or drugs or how much these may be impacting your life, so understandably denial is common when it comes to substance abuse. This is similarly the case with mental health conditions. Symptoms of depression, anxiety or bipolar disorder can be unsettling for some, and the comforting response may be to ignore the problem by denying, downplaying or avoiding it. Some tend to worry about being perceived as weak if they were to admit to a problem like this.

The important fact here is that substance abuse issues are likely to get worse the longer we ignore or deny them. Denial is not the solution. The first step towards overcoming either of these conditions, co-occurring or not, is to admit you have the problem.

Think about your sensitivity to alcohol or drugs. Are you highly sensitive to the effects of alcohol or drugs? Have you noticed a relationship between your substance use and your mental health? For example, do you feel a bit down when you drink?

Think about your family history. If family members have dealt with either a mental disorder (such as depression or anxiety), alcohol abuse or drug addiction, you have a higher risk of developing these problems.

Think about your treatment history. Have you been treated before for either your addiction or your mental health issue? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?

Think about your symptoms when you’re sober. While it’s normal to experience feelings of depression or anxiety after you’ve stopped drinking or doing drugs, if the symptoms persist after you’ve achieved sobriety, you may be dealing with a mental health problem.

Spotting the signs of addiction

The following questions may provide a helpful guide for determining whether you have a drug or alcohol problem. The more you answer “yes”, the more likely your drinking or drug use is a problem.

Do you ever lie about how much or how often you drink or use drugs?

Have your friends or family members expressed concern about your alcohol or drug use?

Have you ever felt you should cut down on your drinking or drug use?

Have you tried to cut back your alcohol or drug use unsuccessfully?

Do you ever feel bad, guilty, or ashamed about your drinking or drug use?

On more than one occasion, have you done or said something while under the influence that you later regretted?

Has your alcohol or drug use caused issues in your relationships?

Have you ever been in trouble at work or with the law due to your drug or alcohol use?

Have you ever blacked out from drinking or drug use?

Spotting the Warning Signs

Depression and anxiety disorders, are the most common mental health problems that co-occur with substance abuse.

Common symptoms of depression

Feelings of being helpless or hopeless

Strong feelings of guilt or worthlessness

Inability to experience pleasure

Loss of interest in daily activities

Weight or appetite changes

Loss of energy

Irregular sleep

Problems concentrating

Physical pain, anger and reckless behaviour

Common symptoms of anxiety

Constant tension and worry

Feeling restless, jumpy, irritable or on edge

Nausea, dizziness or trembling

Racing heart or shortness of breath

Headaches or muscle tension

Lack of sleep

Problems concentrating

Is there a treatment?

While there is no silver bullet that eliminates both conditions, it is possible to effectively treat a co-occurring disorder by addressing both the substance abuse and the mental health condition in one integrated approach. Recovery depends on treating both disorders, no matter which came first or which may seem the more difficult to cope with.

Don’t lose sight of your healthy outcome. With time, commitment, and courage, you can recover from a co-occurring disorder. Take one step at a time, acknowledge and congratulate yourself on the small wins along the way, and like many others who have been through this before, you will get better.

Combine your treatments. You increase your chances of recovery if you combine your treatments for both substance abuse and mental illness. Inquire with your treatment provider or team about getting combined mental health and addiction treatment.

Accept the possibility of relapse. It’s natural to relapse along the way so don’t be disheartened if this happens. Permit yourself these moments but stay committed. Like many who have been through this, you will bounce back and continue on the road to recovery.

Reach out for support. Joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous can give you a chance to lean on others who know what you’re going through. Alternatively build a small circle of trusted friends or relatives with whom you can open up to about your experiences on the road to recovery.

Choosing the right treatment program

It’s important to make sure the program you take on is evidence-based, licensed and accredited and backed up by an aftercare program to prevent relapse. Also ensure that the program has a good track record in dealing with helping you manage depression or anxiety, .

The treatment program you select should:

Address both the substance abuse problem and your mental health problem, providing both counsellors and treatment specifically aimed at addressing these issues.

Provide you with an educational overview of your disorder and related problems and medications.

Involve you in the decision-making process and ensure you are actively involved in setting goals and developing strategies for change.

Dual diagnosis or co-occurring disorder requires professional help and support. If you or a loved one is suffering from dual diagnosis or co-occurring disorderthe first step is to search our directory for a drug & alcohol rehab center which treats addiction and mental illness together. A Psychiatrist will be able to complete a thorough evaluation to determine the right course of treatment, addiction counselling will also most likely be advised from your health care professional.

Getting group support

Connecting with groups can be very helpful for maintaining sobriety, sharing your challenges, being supported and even learning a few tips and insights from people going through the same experience. With some treatment programs for co-occurring disorders, organised groups continue to meet during the aftercare phase. You may also be referred to a group specially organised for people with co-occurring disorders by your treatment provider or doctor.

For the most part, it’s ideal to join a group that addresses both substance abuse and your specific mental health condition, however twelve-step groups for substance abuse can also be beneficial. In fact you are more likely to find one of these groups in your area as they tend to be more common. Facilitated by peers, these free programs use group support and some guiding principles (the twelve steps) to help achieve and maintain sobriety.

It’s essential to flag early with the group the idea of co-occurring disorders and psychiatric medication. Although well-intentioned, some group members may have the view that taking psychiatric medication is merely another form of addiction. The idea must be accepted by group members, as it’s in your best interest to participate in a group environment in which you feel safe and supported, rather than pressured or judged.

Improving self-help for co-occurring disorders

Recovery does not end at getting sober. Your ongoing, sustainable recovery depends on continued mental health treatment, continually learning and applying healthier coping strategies, and making more informed decisions when it comes to handling bumps in the road.

The following helpful tips can assist your recovery;

1: Identify and respond properly to negative emotions and stress

Learn how to deal with stress. When things get stressful it’s important to have some steps in place that interrupt your reliance on alcohol or drugs. Coping skills and stress management go a long way towards preventing relapse and keeping symptoms under control.

Recognise your triggers and have a plan. Whether you’re experiencing big life changes, stressful events, or just unhealthy eating, it’s vital you pick up on the signs that your illness is surfacing or intensifying. When these moments arise, it’s important to have steps in place to prevent drug or alcohol relapse.

2: Stay in touch

Get therapy or stay involved in a support group. If you are part of a support group like Alcoholics Anonymous or Narcotics Anonymous, or if you are getting therapy, your chances of staying sober improve.

Keep following doctor’s orders. It’s easy to believe you no longer need medication once you are sober and feel back to normal. However stopping medication or treatment prematurely is a common cause of relapse in people with co-occurring disorders. Always consult with your doctor before making any decisions about your medication or treatment regime.

3: Make small shifts to your lifestyle

Exercise regularly. Exercise is great for reducing stress and anxiety, and improving your mood and attitude. You don’t have to go to a gym. Partner up with someone and go for some long walks, a bike ride or yoga class.

Improve your sleep. Lack of sleep can increase your vulnerability to stress, anxiety and depression. It’s ideal to get 7-9 hours of quality sleep a night.

Make time for relaxation. Relaxation techniques such as deep breathing, mindfulness meditation and progressive muscle relaxation, when practiced regularly, can reduce symptoms of stress, anxiety, and depression, and promote feelings of calm and happiness as well as improve concentration and productivity. A calm, focused mind is better able to commit to a recovery plan.

Eat healthier. Watch your sugar content and ensure you do not skip meals such as breakfast. These two factors are vital for maintaining healthy blood sugar levels. Both substance abuse and mental health issues, place high demand on the liver and stress hormones. Maintaining healthy blood sugar levels by sticking to a balanced diet helps reduce this burden.

Helping a loved one through this experience

Supporting someone through a co-occurring disorder can be a long and bumpy road that requires patience and consistent, routine contact. Many in this situation find that resistance to treatment is a common challenge.

It helps to start out by accepting what you can and cannot do, and that the approach that may work for you, may not work for others. As much as a disciplined style may suit you, it’s important not to force someone to become sober and stay that way. Nor is it helpful or practical to make someone keep their medical or group therapy appointments or make them take their medication.

A common trap is to become stressed or frustrated and lose yourself in the process of helping someone through a co-occurring disorder. You may begin to disregard your own mental health, abandon your healthy lifestyle choices, even damage your relationship with the person you are helping. Ensure that you continue making positive choices for yourself throughout the process. Encourage your friend or loved one to get help, and offer your support while looking after your own well-being.

Learn up. Educate yourself about your loved one’s mental health problem, substance abuse, treatment and recovery program. The more you appreciate what your loved one is going through, the better able you’ll be to support them.

Set some boundaries. Don’t set yourself up for failure or disappointment. Set boundaries concerning the amount of care you anticipate providing to ensure you don’t end up overwhelmed and resentful. It wouldn’t be healthy for you or your loved one if providing support starts to take over your life.

Take it a step at a time. Be patient. Recognise and celebrate the small achievements to help stay committed and positive. Recovering from a co-occurring disorder does not happen overnight. It can take months or years, and relapse is common.

Seek support. Support for the carer is just as important as support for the person with the co-occurring disorder. The pain and isolation of the experience can affect your own health, well-being and relationships. Make sure you’re getting the emotional support you need to cope. Talk to someone you trust about what you’re going through and consider joining a support group for carers.

Addiction & Anxiety: Understanding the Link

Research over the past two decades has uncovered many interesting facts about the links between addiction and Anxiety. Does one cause the other? Could the presence of both be one and the same condition?

When a substance abuse problem co-exists with a mental health issue such as depression, anxiety or bipolar disorder, we have what is called a dual diagnosis or co-occurring disorder. For those already battling with substance abuse, in some ways this is like taking on a bigger, invisible enemy. But there are steps you can take to win this battle. A combination of proper treatment, support and self-help strategies is vital.

How common is it?

Being diagnosed with both conditions at the same time may seem like an unlucky quirk of fate, but it is not uncommon. According to reports published in the Journal of the American Medical Association:

As many as 50 percent of people with severe mental disorders were also affected by substance abuse.

37 percent of alcohol abusers and 53 percent of drug abusers also had at least one serious mental illness.

Of all those diagnosed as mentally ill, 29 percent abused either alcohol or drugs.

Source: National Alliance on Mental Illness

What comes first?

When we look at substance abuse and mental illness separately, we find that both have in common a set of symptoms that can impact all those things we take for granted: our ability to handle the ups and downs of life, our relationships with others, even the way we physically function. It’s important to consider the way both of these disorders affect each other. Just as a mental health problem gets worse when it’s not treated, drug or alcohol addiction commonly gets worse too. When substance abuse increases, mental health problems tend to escalate also.

But while addiction is common in people with mental health issues, one is not the direct cause of the other. Here are the key ways the two interact:

People with depression or bipolar often rely on alcohol or drugs to self-medicate. While turning to drugs or alcohol can temporarily numb the pain, over the long term it can intensify the original symptoms.

Substance abuse can increase a pre-existing risk of mental illness. It’s estimated that 1 in 5 people carry a diagnosable mental health condition, while the rest of us have varying degrees of risk or vulnerability. If you already possess an underlying mental illness, drug or alcohol abuse may bring it to the surface.

Substance abuse can intensify the symptoms of a mental health condition. Alcohol and drug abuse may significantly increase symptoms of mental illness or give rise to new symptoms. Substance abuse also interacts with medications including antidepressants, anti-anxiety medication, and mood stabilisers, reducing their effectiveness.

Being honest with yourself

Identifying a mental health issue is a complex process and can take time to determine with certainty. Similarly, knowing for sure that a drug or alcohol problem is present can be fraught with difficulty.

Denial is one of the biggest obstacles that can block a dual diagnosis. It’s not easy to admit how dependent you are on alcohol or drugs or how much these may be impacting your life, so understandably denial is common when it comes to substance abuse. This is similarly the case with mental health conditions. Symptoms of depression, anxiety or bipolar disorder can be unsettling for some, and the comforting response may be to ignore the problem by denying, downplaying or avoiding it. Some tend to worry about being perceived as weak if they were to admit to a problem like this.

The important fact here is that substance abuse issues are likely to get worse the longer we ignore or deny them. Denial is not the solution. The first step towards overcoming either of these conditions, co-occurring or not, is to admit you have the problem.

Think about your sensitivity to alcohol or drugs. Are you highly sensitive to the effects of alcohol or drugs? Have you noticed a relationship between your substance use and your mental health? For example, do you feel a bit down when you drink?

Think about your family history. If family members have dealt with either a mental disorder (such as depression or anxiety), alcohol abuse or drug addiction, you have a higher risk of developing these problems.

Think about your treatment history. Have you been treated before for either your addiction or your mental health issue? Did the substance abuse treatment fail because of complications from your mental health issue or vice versa?

Think about your symptoms when you’re sober. While it’s normal to experience feelings of depression or anxiety after you’ve stopped drinking or doing drugs, if the symptoms persist after you’ve achieved sobriety, you may be dealing with a mental health problem.

Spotting the signs of addiction

The following questions may provide a helpful guide for determining whether you have a drug or alcohol problem. The more you answer “yes”, the more likely your drinking or drug use is a problem.

Do you ever lie about how much or how often you drink or use drugs?

Have your friends or family members expressed concern about your alcohol or drug use?

Have you ever felt you should cut down on your drinking or drug use?

Have you tried to cut back your alcohol or drug use unsuccessfully?

Do you ever feel bad, guilty, or ashamed about your drinking or drug use?

On more than one occasion, have you done or said something while under the influence that you later regretted?

Has your alcohol or drug use caused issues in your relationships?

Have you ever been in trouble at work or with the law due to your drug or alcohol use?

Have you ever blacked out from drinking or drug use?

Spotting the Warning Signs

Depression and anxiety disorders, are the most common mental health problems that co-occur with substance abuse.

Common symptoms of depression

Feelings of being helpless or hopeless

Strong feelings of guilt or worthlessness

Inability to experience pleasure

Loss of interest in daily activities

Weight or appetite changes

Loss of energy

Irregular sleep

Problems concentrating

Physical pain, anger and reckless behaviour

Common symptoms of anxiety

Constant tension and worry

Feeling restless, jumpy, irritable or on edge

Nausea, dizziness or trembling

Racing heart or shortness of breath

Headaches or muscle tension

Lack of sleep

Problems concentrating

Is there a treatment?

While there is no silver bullet that eliminates both conditions, it is possible to effectively treat a co-occurring disorder by addressing both the substance abuse and the mental health condition in one integrated approach. Recovery depends on treating both disorders, no matter which came first or which may seem the more difficult to cope with.

Don’t lose sight of your healthy outcome. With time, commitment, and courage, you can recover from a co-occurring disorder. Take one step at a time, acknowledge and congratulate yourself on the small wins along the way, and like many others who have been through this before, you will get better.

Combine your treatments. You increase your chances of recovery if you combine your treatments for both substance abuse and mental illness. Inquire with your treatment provider or team about getting combined mental health and addiction treatment.

Accept the possibility of relapse. It’s natural to relapse along the way so don’t be disheartened if this happens. Permit yourself these moments but stay committed. Like many who have been through this, you will bounce back and continue on the road to recovery.

Reach out for support. Joining a self-help support group like Alcoholics Anonymous or Narcotics Anonymous can give you a chance to lean on others who know what you’re going through. Alternatively build a small circle of trusted friends or relatives with whom you can open up to about your experiences on the road to recovery.

Choosing the right treatment program

It’s important to make sure the program you take on is evidence-based, licensed and accredited and backed up by an aftercare program to prevent relapse. Also ensure that the program has a good track record in dealing with helping you manage depression or anxiety, .

The treatment program you select should:

Address both the substance abuse problem and your mental health problem, providing both counsellors and treatment specifically aimed at addressing these issues.

Provide you with an educational overview of your disorder and related problems and medications.

Involve you in the decision-making process and ensure you are actively involved in setting goals and developing strategies for change.

Dual diagnosis or co-occurring disorder requires professional help and support. If you or a loved one is suffering from dual diagnosis or co-occurring disorderthe first step is to search our directory for a drug & alcohol rehab center which treats addiction and mental illness together. A Psychiatrist will be able to complete a thorough evaluation to determine the right course of treatment, addiction counselling will also most likely be advised from your health care professional.

Getting group support

Connecting with groups can be very helpful for maintaining sobriety, sharing your challenges, being supported and even learning a few tips and insights from people going through the same experience. With some treatment programs for co-occurring disorders, organised groups continue to meet during the aftercare phase. You may also be referred to a group specially organised for people with co-occurring disorders by your treatment provider or doctor.

For the most part, it’s ideal to join a group that addresses both substance abuse and your specific mental health condition, however twelve-step groups for substance abuse can also be beneficial. In fact you are more likely to find one of these groups in your area as they tend to be more common. Facilitated by peers, these free programs use group support and some guiding principles (the twelve steps) to help achieve and maintain sobriety.

It’s essential to flag early with the group the idea of co-occurring disorders and psychiatric medication. Although well-intentioned, some group members may have the view that taking psychiatric medication is merely another form of addiction. The idea must be accepted by group members, as it’s in your best interest to participate in a group environment in which you feel safe and supported, rather than pressured or judged.

Improving self-help for co-occurring disorders

Recovery does not end at getting sober. Your ongoing, sustainable recovery depends on continued mental health treatment, continually learning and applying healthier coping strategies, and making more informed decisions when it comes to handling bumps in the road.

The following helpful tips can assist your recovery;

1: Identify and respond properly to negative emotions and stress

Learn how to deal with stress. When things get stressful it’s important to have some steps in place that interrupt your reliance on alcohol or drugs. Coping skills and stress management go a long way towards preventing relapse and keeping symptoms under control.

Recognise your triggers and have a plan. Whether you’re experiencing big life changes, stressful events, or just unhealthy eating, it’s vital you pick up on the signs that your illness is surfacing or intensifying. When these moments arise, it’s important to have steps in place to prevent drug or alcohol relapse.

2: Stay in touch

Get therapy or stay involved in a support group. If you are part of a support group like Alcoholics Anonymous or Narcotics Anonymous, or if you are getting therapy, your chances of staying sober improve.

Keep following doctor’s orders. It’s easy to believe you no longer need medication once you are sober and feel back to normal. However stopping medication or treatment prematurely is a common cause of relapse in people with co-occurring disorders. Always consult with your doctor before making any decisions about your medication or treatment regime.

3: Make small shifts to your lifestyle

Exercise regularly. Exercise is great for reducing stress and anxiety, and improving your mood and attitude. You don’t have to go to a gym. Partner up with someone and go for some long walks, a bike ride or yoga class.

Improve your sleep. Lack of sleep can increase your vulnerability to stress, anxiety and depression. It’s ideal to get 7-9 hours of quality sleep a night.

Make time for relaxation. Relaxation techniques such as deep breathing, mindfulness meditation and progressive muscle relaxation, when practiced regularly, can reduce symptoms of stress, anxiety, and depression, and promote feelings of calm and happiness as well as improve concentration and productivity. A calm, focused mind is better able to commit to a recovery plan.

Eat healthier. Watch your sugar content and ensure you do not skip meals such as breakfast. These two factors are vital for maintaining healthy blood sugar levels. Both substance abuse and mental health issues, place high demand on the liver and stress hormones. Maintaining healthy blood sugar levels by sticking to a balanced diet helps reduce this burden.

Helping a loved one through this experience

Supporting someone through a co-occurring disorder can be a long and bumpy road that requires patience and consistent, routine contact. Many in this situation find that resistance to treatment is a common challenge.

It helps to start out by accepting what you can and cannot do, and that the approach that may work for you, may not work for others. As much as a disciplined style may suit you, it’s important not to force someone to become sober and stay that way. Nor is it helpful or practical to make someone keep their medical or group therapy appointments or make them take their medication.

A common trap is to become stressed or frustrated and lose yourself in the process of helping someone through a co-occurring disorder. You may begin to disregard your own mental health, abandon your healthy lifestyle choices, even damage your relationship with the person you are helping. Ensure that you continue making positive choices for yourself throughout the process. Encourage your friend or loved one to get help, and offer your support while looking after your own well-being.

Learn up. Educate yourself about your loved one’s mental health problem, substance abuse, treatment and recovery program. The more you appreciate what your loved one is going through, the better able you’ll be to support them.

Set some boundaries. Don’t set yourself up for failure or disappointment. Set boundaries concerning the amount of care you anticipate providing to ensure you don’t end up overwhelmed and resentful. It wouldn’t be healthy for you or your loved one if providing support starts to take over your life.

Take it a step at a time. Be patient. Recognise and celebrate the small achievements to help stay committed and positive. Recovering from a co-occurring disorder does not happen overnight. It can take months or years, and relapse is common.

Seek support. Support for the carer is just as important as support for the person with the co-occurring disorder. The pain and isolation of the experience can affect your own health, well-being and relationships. Make sure you’re getting the emotional support you need to cope. Talk to someone you trust about what you’re going through and consider joining a support group for carers.